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Securing a healthy system

By Stephen Leeder - posted Monday, 30 January 2006

The recent report from the Productivity Commission offers strong guidance about how to allocate university places to reflect a better balance among those with different views about the development of the health workforce.

The commission proposes that an agreement be struck between the Federal Government and each state and territory "covering the allocation of available funding for university-based education and training of health workers".

"Workforce" is a term that smells of military might and cordite. So the phrase "health workforce" is odd, even contradictory. Health workers regard themselves as professionals who seek to preserve and restore health. If they are aligned at all with the military, then it is with peacekeepers.


Another view of the health workforce is that of those who are responsible for health services. Those who manage health services ensure that health care is delivered on time, at high quality, where it is needed. They need foot soldiers - doctors, nurses and other health professionals - and they need them now. Yet health service managers feel that they have little or no say in how many, and what type of, health workers emerge from Australian education and training. Why does it take so long, they ask, to train effective practitioners?

Yet another view of the health workforce is held by those who manage Medicare. To them, a healthcare worker, especially a doctor, is a cost generator, like a teenage son on a spending spree with Dad's credit card. Each doctor spends $300,000 (or more) each year in treating sick people when you count Medicare rebates, pharmaceutical benefits and so on. The fewer the better.

As for university managers, they know that medicine, in particular, brings research money to the university, but this can be a drain on infrastructure, taking resources from the training of the next generation in other professions. The intense interest of the Federal Government (the departments of health and ageing, and education, science and training) in numbers of medical student places, the expectation that universities will offer rural training (often handsomely funded) and incentive scholarship schemes: all of this adds to the administrative and political load in universities.

Thus, many parties are interested in health workforce development and their agendas often clash.

Little wonder, then, that there is such intense interest in questions of how many healthcare workers there should be, of what professional brand (GPs, nurses, physiotherapists), what skills they should possess and how they should be educated, trained, financed and managed.

Thus the report of the Productivity Commission, Australia's Health Workforce, has done remarkably well in a short time to address these questions and point to ways in which we might answer them.


The fifth chapter, devoted to education and training, is of great interest to the tertiary education and training sector. At issue are both the number of funded university positions for healthcare worker students and the curricular style and content on offer.

The report identifies as the first priority a deficiency in co-ordination mechanisms "both within the education and training area and between this area and the other key components of the health workforce regime". Clinical training for medical students is offered as an example, but the concerns of pharmacy, physiotherapy, podiatry and others are similar.

There are too few opportunities for supervised practical education. Universities do not receive adequate funding for these courses.

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First published in The Australian on January 25, 2006.

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About the Author

Stephen Leeder is professor of public health and community medicine at the University of Sydney, and co-director of the Menzies Centre for Health Policy.

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